Health Care Costs Too Much, But Don’t Limit My Choices

By Theo Francis

The problems consumers cite in health care and what they want from the system are out of whack, a new survey from the Mayo Clinic suggests.

Nine in 10 respondents said health-care costs are too high. But eight in 10 called it very or extremely important that patients should have “freedom of choice” to pick insurers, hospitals and doctors. Some 72% said no one should be denied coverage for pre-existing conditions, and 70% think care should be based on patients’ preferences and needs.

Some currently hot policy ideas got less full-throated — but still solid — support, including a federal health board modeled on the Federal Reserve, mandatory health insurance and encouraging patients to have a “medical home,” or one primary-care provider to coordinate treatment. Nearly two-thirds thought it “important” or “very/extremely important” that the federal government “play an important role in funding health-care.”

And who did they expect to fix the problems? Thirty-six percent said insurance companies had the “greatest ability to affect change,” followed by doctors and other providers at 32%, Congress at 31% and consumers at 29%. The president tied with hospitals and individual state legislatures at 16%. (Just 6% thought the news media had much chance of changing things, trailing even “none/don’t know.” We could have told them that without the survey.)

Oh, and the chance of anything actually happening? Just 17% think reform is likely in the next decade. Another 17% are on the fence. We’ll do the math for you: Two-thirds think it ain’t likely.

The online survey was conducted by Harris Interactive for Mayo during the third week of December. Participants included 1,018 U.S. residents, age 25 to 75. They were involved in making health-care decisions for their households.

Comments (5 of 19)

Cool story as for me. I'd like to read something more concerning this topic. Thanks for posting that material.

11:59 am April 22, 2008

Peter wrote :

It's time for Americans to take charge of their health and its associated costs. We live in a society where competition drives efficiencies as well as value. It's time to stand up and say "Sorry, that costs too much and I won't take it anymore." In fact, I read something recently, which I included below, that seems to speak to the idea that if we can't find reasonably affordable healthcare here, then let's take an active rather than reactive approach to finding that affordability. The story below is not written by me, but I think it makes a really valid point.
-Fed-up in New York, New York

Health crisis

Health care in America is in crisis (”Five myths of health care,” Commentary, March 21). Turn on the news, listen to the political candidates or simply speak with your friends and neighbors who are in need of or seeking medical treatment. The cost is high; the availability of service is sometimes inadequate and often unavailable to far too many who need it.

While it is abundantly clear that Americans in general, and the presidential candidates in particular, are keenly aware of the concern regarding ever-escalating health care costs, it appears their response is at best one-dimensional. In order to make a serious dent in the problem, we must own up to the fact that a multidimensional approach is necessary.

Asking who will pay for health care is certainly important, and each of the candidates has mapped out their own particular approach. Sen. Barack Obama is calling for incentivizing insurance for all, while Sen. Hillary Clinton wants to mandate insurance for every American. Meanwhile, Sen. John McCain is attempting to offer tax breaks or credits to help enlist almost all of the uninsured. While they’ve done the important work of opening a dialogue on the issue and who will pay, they have not yet begun to answer the question of how to pay for what they are offering.

It is significant to note that Mrs. Clinton has not explained how she will force people to buy insurance, presumably because the mention of any type of force might have voters running for cover.

However, each plan addresses only how risk will be allocated. None of the offered plans discuss how we will begin to pay for the resulting benefits. For the Democrats, the closing of loopholes for the rich does not come close to the total cost by even the most conservative estimates. As an aside, with commitments to increase entitlement spending without raising taxes, even a third grader would question the math.

Conversely, the Republican Mr. McCain will not close the loopholes of the rich and fails to indicate from where the funding will be obtained.

The sad truth is health care spending in the United States is currently 16 percent of the Gross Domestic Product, according to the National Coalition on Health Care. Simply stated, that means for every dollar produced in this country, 16 percent goes to fund health care. Our health care costs far outpace our rate of inflation and, as a result, the problem is not getting better. Factor in the “graying of America,” where we will have a higher percentage of senior citizens in coming years, along with our recently legislated Medicare program, which lacks any discernible source of funding, and at best the outlook is bleak.

In order to responsibly deal with health care costs, allocation of risk is not enough. We must seek meaningful and tangible ways to diminish the actual cost of health care.

Mr. McCain has touched on tort reform, proposing that the reduction of settlements in medical malpractice cases would serve to lower the insurance premiums every doctor must pay, thus lowering overall health care costs. Other suggestions include allowing people to import medication from other locales to alleviate related medical costs.

Yet another answer may be the recognition that there are overseas destinations providing comparable or substantially better levels of health care than what might be available in the United States for a fraction of the cost. In addition, access to doctors is generally believed to be better in certain foreign locations.

Meanwhile, in the United States, the continued rise in health care costs is readily in evidence. In the last few weeks in the New York market alone, Cabrini Medical Center closed and Victory Memorial announced it will soon be auctioned.

I do not think there is just one answer to the complexities of addressing the health care dilemma. However, I believe if we fail to keep an open mind and neglect to recognize that, as a complex problem, the answer must be multidimensional, we will not be able to adequately address our needs.

MENDEL ZILBERBERG

President and CEO, One World United

Brooklyn

1:26 pm March 12, 2008

judahbear wrote :

Anne-Marie,

My fees have always been posted on a sign outside my office, on my website (www.patmosemergiclinic.com), on the front desk, and several years ago on billboards. The hospital I mentioned in my first post will not provide prices for even simple things like labs and X-rays - yet they are tax-exempt (i.e. non-taxpayers...freeloaders). I have written them several times (my letters and their answers are also on this website).

The best way to make doctors cut back on tests is to have patients pay for them, which makes both doctors and patients accountable for their decisions. Since the vast majority of my patients have no other choice but to pay out of their own pockets I have to give them reasons why they should have a test done. I draw labs here and a national lab picks them up everyday - cost to the patient between $20 and $30. There is a medical office about 25 miles away that does plain X-rays for about $60, radiologist's interpretation included. Many of my patients drive right passed the local hospital that won't provide its prices (but charges about $200 for the same X-rays) to go to this taxpaying facility in the nearby town. I also dispense many generic medicines from the practice for $5 -10 which saves them time and sometimes money. Most of the pharmacies in addition to WalMart also now have substantially discounted medicines that are adequate for my patients - but it is their choice if they want to buy the $100 name brand if they feel it is worth it. Sometimes $4 ranitidine won't work for heartburn and they have to pay over $100 per month for Prevacid or Nexium - it is their decision. Now we just need to funnel those healthcare dollars back to ordinary Americans to allow them to make the tradeoff decisions that are currently being made by third party payers.

By the way, comprehensive annual physicals have been shown in numerous studies to not be time effective or cost effective. Focused annual exams based on past medical history, family history, and age are much more cost effective. And I don't want any third party setting my fees. If they are too high, patients will go to someone less expensive. Or maybe they will come to me despite a higher fee because they feel I am worth it...Again their decision.

10:22 am March 12, 2008

Anne-Marie wrote :

I know this seems simplistic, but why not instead of govement insurance, we just pay the doctor fee and have a 75% deductible for medical fees paid in that year, when filling our income taxes,
There should be a line in adjusted income section; in which you put the amount you paid for medical bills (all medical bills including dental and vision care) and you get to subtract 75% of that from your gross income. That would make your adjusted income lower,and your taxes less and a larger tax return.

All doctors offices and hospitals should display their fees for various procedures and office visits.

Uninsured patients should also learn to negotiated fees with their doctors and hospitals just like insurance companies do.

We should welcome back small Family medical practice doctors.

Doctors should start rejecting drug companies who push their expensive drugs, often with multiply sideffect and look for natural alternatives.

Doctors should also cut down on number on test given to patients,which are sometimes are not necessary.

The best way to prevent high cost of medical treatment, is to administer preventive care, not drugs but regular yearly physicals at a low cost. Maybe this should be mandatory, just like car have to pass an inspection. Maybe all humans should be required to take a yearly physical.
A set fee across the broad, nationalwide.

That's my humble and simplistic opinion.

9:39 am March 12, 2008

judahbear wrote :

Congratulations fo "smallmd" for finding a way to survive in a system rigged against the small medical practice while still taking insurance. The difference is I don't sign contracts with any insurance companies. Nor do I have a nurse. I administer my own injections and draw the labs my office assistant has difficulty with. I have 8000 patient charts but see only about 5000 patients a year because my clinic is open only about 1500 hours a year (although I spend a lot of time charting, and following up with patients and on behalf of patients after clinic).

I have taken Dr. Bennett's comments to heart. I had been working many more hours but decided to cut back substantially to improve and maintain my health (lost 25 lbs and no longer am a borderline diabetic). I also realize that at age 49, neither Medicare nor SS is likely to be of much help to me beyond 65...so I plan to work into my 70's. So I am not going to kill myself now to save up retirement that could be confiscated by the govt anyway when prolonging my retirement is a more secure decision. AFter all the ill and injured we will always have with us - even if we no longer have Medicare or SS in the form it is today.

Mr. Murray makes some very good points about our financing system...there seems to be a lot more administrative waste when compared with single payer systems. But single payer systems also pay for routine medical care, which is a waste. Since I bill no one, my administrative overhead must be less than primary care clinics in Canada. Direct payment has lower transaction costs than single payer payment. It also guarantees that I work for the patient and not the govt...giving the patient the time required to address his/her problems appropriately rather than running people through like cattle. One of the major ethical problems with signing contracts with third party payers is that they dictate the terms - the doctor has no say in what he is compensated or how much overhead he must endure to settle the small claims...and the patient gets squeezed into 8 minute visits just so the doctor can pay his overhead. The third party payer system does not do justice to the humanity of the doctor patient relationship. It is unethical.